World Bank HIV/AIDS programs less effective than its other health programs, report finds

World Bank programs aimed at fighting HIV/AIDS, particularly in Africa, are less effective overall than World Bank programs aimed at addressing other health and development issues, according to a report released Thursday by the organization's Independent Evaluation Group, the New York Times reports.

The report assessed the World Bank $17 billion investment in health, nutrition and population programs since 1997. According to the report, seven of 10 World Bank HIV/AIDS programs worldwide, and eight of 10 in Africa, had unsatisfactory results (Dugger, New York Times, 4/30). HIV/AIDS programs in Africa had a 25% success rate, compared with 80% success rate for all World Bank programs, the report found. In addition, one-third of World Bank nutrition, health and population programs from 1997 to 2007 did not produce satisfactory results. However, some programs were very successful, including a malaria campaign in Eritrea that reduced malaria deaths by 85% (Faiola, Washington Post, 5/1). HIV/AIDS programs accounted for about 60% of the bank's communicable diseases projects between 1997 and 2006. Meanwhile, malaria programs accounted for 3% of projects and tuberculosis programs for 2%, the report said. In addition, the report noted that World Bank reduced its support for family planning and other issues, such as malnutrition, as it allocated more resources to HIV/AIDS (New York Times, 4/30).

The report cited weak monitoring and infrastructure, poor implementation and overly complex programs as reasons for the unsatisfactory results, noting that a $26.6 million HIV/AIDS program conducted in Ghana from 2000 to 2005 did not target people at risk of contracting HIV (Washington Post, 5/1). Difficulties in coordinating collaboration with donors, not-for-profit groups and government agencies also made it difficult to ensure the programs delivered results, the report said (New York Times, 4/30). In addition, the report noted that evaluation of programs was "almost nonexistent" and cautioned that "excessive earmarking" of programs for communicable diseases could weaken health systems (Jack, Financial Times, 4/30).

The report recommended that the World Bank simplify programs, reduce the number of government agencies involved and have more modest goals. Martha Ainsworth, lead author of the report, added that efforts to reduce high fertility rates also are needed. "The fact that no one's been paying attention to reducing high fertility is critical for Africa," Ainsworth said (New York Times, 4/30). The World Bank noted that it is tripling its commitment to health programs to $3 billion in the current fiscal year and plans to focus on efforts to strengthen health systems.

Comments

The report also called for increased efforts to reinforce accountability (Financial Times, 4/30). The bank said it would look into ways to streamline existing programs but noted that it can be challenging to operate programs under difficult conditions in certain regions. "I accept much of the report; I accept it as constructive criticism," Julian Schweitzer -- World Bank director of health, nutrition and population -- said, adding, "In hindsight, some of these projects were too complex. But I also want to make a point that health is complicated. It is very hard to develop a good health system."

According to the Post, the report was released as governments are being called on to provide billions in aid to help institutions such as the World Bank address the financial crisis. In addition, the bank is planning to increase emergency programs to address the swine flu outbreak. Eswar Prasad, senior fellow at the Brookings Institution and a professor of trade policy at Cornell University, said the report is a "cautionary note about long-held concerns that money to these institutions can generate a lot of waste" (Washington Post, 5/1). William Easterly, an economics professor at New York University, added that the report confirmed a "fear that many of us have had for some time: that hugely disproportionate attention to AIDS has had a negative effect on aid efforts for all other health problems" (New York Times, 4/30).

The report is available online.